Diabetic kidney disease screening — RACGP Fellowship MCQ

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EasyChronic disease managementDiabetic kidney disease screeningRACGP Fellowship

A 62-year-old woman with type 2 diabetes asks why she needs a urine test when her blood glucose readings are acceptable. Her eGFR is 78 mL/min/1.73 m² and she is normotensive. What is the most appropriate investigation?

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Correct answer: A — Urine albumin:creatinine ratio

The correct answer is A: Urine albumin:creatinine ratio. Early detection of albuminuria via UACR is essential in all patients with type 2 diabetes because it identifies kidney damage years before eGFR falls and guides nephroprotective therapy. Her normal eGFR and good blood pressure control do not exclude albuminuria; in fact, type 2 diabetes can cause kidney damage through non-albuminuric pathways as well, making universal screening critical. Distractors reflect misunderstandings: monthly microscopy is excessive and not evidence-based; 24-hour urine collection is cumbersome and has been replaced by spot UACR in modern practice; renal artery imaging is for suspected secondary causes, not diabetes screening; and cystatin C is a supplementary glomerular filtration marker, not a screening test for kidney damage.

Reference: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD; ADA Standards of Medical Care in Diabetes-2024; RACGP and CARI guidelines for prevention of progression of kidney disease in diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620115/